This disturbing photo is from an excellent article on Solitary Watch about the inhumane and brutal treatment of mentally ill people in US prisons. In my ten years teaching minors locked up in a New York adult county prison, I witnessed inmates who were clearly disturbed and dealing with mental health issues being pepper sprayed and tased by emergency response teams (ERTs) dressed in intimidating riot gear as a way to “calm them down.”

Our prisons are overcrowded with mentally ill people who get little to no treatment, handled by people not trained in these issues, all because Americans refuse to confront the needs of the poor and disenfranchised and to provide the funds necessary for proper community mental health services. Instead we, through our lawmakers, spend billions of dollars on war in its many forms.

Many people who work with youth locked up in prisons or in juvenile detention centers aren’t just teachers, nurses, social workers. Something else compels them to stay at a job in what can be some of the most unwelcoming places you can imagine—and are designed to be that way. Something else stirs them, inspires them to put up with harsh working conditions, and with the frustration of having their efforts often garner only poor results. As challenging as the job is, even more challenging is finding answers to the Big Questions: “Why do I do this kind of work?” “Why do I stay here?” “What’s the point of what I do?” Answers don’t come easily, if they come at all, and their comfort rarely stays around long, but it’s a process many of us in the field go through.
What I appreciate about today’s guest contributor is her willingness to share the struggle, the process she has gone through to answer some of those questions with honesty and humility. Shannah is a Family Nurse Practitioner “in one of New England’s highest security long-term juvenile treatment facilities.” Even that short description from her piece gives you pause when you read it. Yet she conveys so well her commitment to these young boys whose lives seem bleak and hopeless. At the same time she doesn’t hesitate to talk about her frustrations, confusion and fears as she searches for meaning in what she does. Her compassion and her understanding of what’s ultimately important in these kids’ lives—and in the end, in all our lives—is deeply moving.

Helping Young Offenders Find Hope in the Everyday

“We think our darkness is our rap sheet, but it’s not true. Our darkness is that we don’t see the truth of who we are, we don’t see ourselves as God does…The darkness is we don’t see that we are exactly right…The people who walk through darkness have seen great light. It’s not about moving from the dark terrible past to the light, it’s about recognizing that the light has been there all along. It’s right here. We just have to see it.” Father Greg Boyle, Author of “Tattoos on the Heart and Founder and Director of Homeboy Industries”

“The darkness is that we don’t see that we are exactly right.” I think about this a lot in my 4th year as a Family Nurse Practitioner in one of New England’s highest security long-term juvenile treatment facilities. Here, we are not lacking for rap sheets. My patients are 15-20 year old young men who, via a series of unfortunate events and/or choices, are serving long term treatment sentences for crimes that range from carjacking and firearm possession to armed robbery and attempted murder. The facility itself is a 57-year-old concrete building sandwiched between a funeral home and an adult Department of Corrections building. As if to finalize the irony, two cemeteries flank the facility’s front and back. It’s secured with barbed wires, surveillance cameras, obscenely large locks, and an acute sense of vigilance around all things “policy.”

On high-alert, I spent the first month debating whether or not to wear my hairpins with the sharp ends to work, and settled on a ponytail. I worried about unwittingly supplying an underground tattoo ring with my misplaced pens, and I had more than one nightmare in which I “forgot to lock the door” and someone escaped. While it didn’t take long to learn to follow the rules of the building, it’s only in the last three years that I’ve found clarity about the role I play at the center and in the lives of the boys.

My professional job description is straight-forward: “Unit manager and primary healthcare provider responsible for managing all aspects of acute, chronic, and routine healthcare for young men in custody.” But if the description were all-inclusive, it would also say, “Nurse, den-mother, phlebotomist, secretary, boo-boo kisser, nutritionist, custodian, pep squad.” With an average of 15-20 residents at a time, and not a mother in sight, no concern is too small for placement on the daily sick list.

Outsiders are often horrified when I tell them where I work, and there are times I struggle to convey my feelings about the residents and the circumstances that bring us together. How can I capture the complexities of the human spirit or the chronic adversities these boys have endured? How do I relay the feeling in my stomach upon entering the unit after a particularly violent incident, and hearing that abnormal silence beyond the static of the security radio? The boys’ time in custody –weeks, months, and years—is intensely emotional and challenging, and we bear witness together daily. It takes a toll.

At times I’ve felt defeated and heartbroken by obstacles that feel insurmountable: kids picking on each other or becoming obese before my eyes; young men feeling frightened, homesick, or abandoned. Some have lots of visitors; others don’t invite anyone to visit because the pain of family not showing up is far more destructive than being alone.

I wonder what it’s like for them, living out these painfully self-conscious adolescent years being raised by guards, in-between timed phone calls and 30 minute visits with family. Will they ever forget the weight of chains and shackles, the sounds of a physical restraint, or the oppressive atmosphere during a lockdown?

When I was new at this job, I sought out details of their home lives, their charges, their gang involvement, as a way of understanding what they’d been through. I cared deeply about the boys and thought that by understanding their pasts, I’d be able to change something about their futures. Under the weighty ambition of “saving” my patients, I felt constrained by the minutiae of the job itself. Documenting clinic visits and handling administrative duties felt at odds with my desire to make a “real” difference.

Over time, as I watched the majority of boys leave the facility only to return days-to-months later (or worse, landing in adult jail), I became resigned that my impact on their worlds would be minimal. More to the point, I felt like I was failing my patients. Over and over again I asked, “How can we stand by and watch as generation after generation of our babies, our children, our young men steadily march their way to a place where few return unscathed – if they return at all?”

To combat this despair, I created a file on my phone called “Moments,” meant to capture the sweet or poignant interactions with the boys:

Discovering that AH likes to draw, asking to see the pictures he’s drawn and carefully laminated to put on his wall…watching him show off his work and reference a stack of animal books he likes to draw from.

The sheepish smile on SL’s face when he called me upstairs “to see his healing finger” but then shared the REAL reason he called for me…busting at the seams, he shares that he’s gotten into school and “passed” his job interview. So shy and so proud.

DJ during testing—“I know my Mom loves me but she doesn’t show it. I need her to show it. Doesn’t call for three days if I don’t call. Probation officer and court think I am a bad kid – I don’t care what people think.”*He says he likes it here b/c he gets fed and gets to chill and joke around. Going to live with foster family if possible. Likes to fight. Holds anger inside.

JP—the collision of fear, betrayal, anger, pain, embarrassment, adrenalin, pride, sadness, bewilderment, when he was beaten by three other residents. Face swollen and deformed, pacing, hating every tear that falls, vacant eyes.

And moments I struggled to put into words:

KJ—the smile on his face and the twinkle in those deep eyes as he left the building today (after 12+ months). What are you going to do when you get out? “Gonna have a mother’s day. Spend some quality time with my Moms.” Bittersweet—wanting to cry both for all the awesome potential and my own deep concern for his safety. Saying good-by. How proud I am of him. How badly I want him to know his worth. Don’t know how to communicate this to him.

Collecting these moments has kept me in the present over and over again, as well as helped me realize two important truths that I’d failed to see earlier.

First, as their Nurse Practitioner, I’m granted the privilege and responsibility of partnering with my boys in caring for their health, physical well-being, and hearts. I had spent so much time lamenting what I couldn’t change for them that I had missed the tremendous progress we were already making together on these issues. By turning my attention towards a “better” tomorrow, I wasn’t present to the moments already woven into the rich and complex fabric of daily life at the facility—a youth detention center, yes, but for some, the safest, most consistent “home” they’ve known. As I began to change my thinking from “not enough” to the “time is now,” I saw that the most powerful way to make the difference I am committed to making with these boys is to show up and be present, day after day, moment after moment—and I do.

I also saw that my desire to rewrite the past—in an attempt to orient our youth towards a different future—was well-meaning, but it missed the mark. While I still ask the questions—“How do we move forward, and what’s going to make THE difference?”— I now look for the answers in a different place. The answers don’t exist in their past, their stories about themselves, their home lives, or their rap sheets, but in who they are, right here and right now—beautiful, resilient, wise, courageous young men.

As a healthcare provider, I have the opportunity to create a space for my patients in which they get to show up larger than they ever thought they could be. These kids light up my world on a daily basis, and I feel that the least I can do is offer them a place to “arrive,” a place that we create together, moment by moment, where they get to show up as perfect—exactly as they are and as they are not—and so recognize their own light, the one that’s blazing brightly, “the one that’s been there all along.”

Although I more frequently write about the fate of young offenders locked up in our nation’s jail, I was deeply moved by the article and wanted to call attention to it. Lately I’ve been more and more aware that the fate of all the children and young people that the criminal justice system consigns to living behind bars will, if changes are not made in how we treat juvenile offenders, lead to the same fate facing the men and women talked about in this article, “The Other Death Sentence.”

In my own experience teaching in a county prison I would see old men–stooped, hollowed out by disease and hard living, some shuffling along barely able to walk, some using aluminum walkers–and wonder, “What did you do to get yourself in here?” My incredulity was often shared by others. I’d overhear correctional officers and other inmates greeting these old men respectfully as “papi,” or “pops,” commenting to them that they should be home with their grandchildren. There was never any contempt in those remarks, just real sadness and pity at these men’s lives. Even the kids I taught would talk about how they needed to get their lives together so they didn’t end up like those “old timers.”

So as Americans insist on “tough” criminal laws and harsher sentences as a solution to our crime problems, our prisons will continue to fill up with men and women, growing old, getting sick and dying. Even if one isn’t moved by humanitarian concerns for this population, the economic ramifications should be bleak enough to make us all stop and reexamine the best way to prevent crime.

CNN Justice (11-13-2009) did an interesting and enlightening story on the United States aging prison population and the need for increased and more expensive health care.

Americans hold firm to their belief that the only way to deal with crime is to lock people up. It’s been a “successful” strategy as the PEW Trust reported in 2008. America now incarcerates 1 in 100 of its citizens. As expensive, and as dangerous as this policy is, the public still insists that adults and young people charged with crimes should be locked up in places that only teach them more crime, instill more anger and resentment and self-loathing. This policy not only doesn’t prevent crime but also endangers the health and well being of yet another generation. It costs Americans more money, money they resent spending on “ruthless thugs,” but money that has to be spent because of their shortsighted approach to criminal justice.

In my ten years teaching in an adult prison with locked up teenagers, some as young as 15, the correctional staff I worked with would often joke (in that “black humor” way of COs) that it was okay with them for these young inmates to keep getting arrested; all they were doing was guaranteeing the COs’ jobs and retirement. The edge in the COs’ comments was there, but so was the dark wisdom: Kids get in trouble, the system locks them up, then sends them back out into the world punished but not changed or given help in any way, only to get in trouble again. After awhile, they’re not kids any more but the adults the PEW Report talked about and that the CNN Justice story highlighted. Instead of breeding another generation of criminals, and having to pay for them, maybe it’s time to look at other ways to teach people, young and old, to be accountable for their actions.